Abstract

HIV associated immune dysregulation is linked with increased risk of HIV and non-HIV related cancers. Substance abuse, particularly alcohol can increase risk of cirrhosis and the likelihood of liver related death. The high rate of smoking in people with HIV is of concern against a background of immunodeficiency. In this study we describe alcohol and drug use in the WA HIV Cohort over a five year period and current statistics on smoking in order to guide multidisciplinary, preventive health measures in our hospital setting.

388 patients (85% male) attending the RPH Immunology Outpatient Clinic in 2002 and 2008 (2002: n=215, 2008: n=158, both: n=60) completed a self-report questionnaire (Q) on: alcohol intake: use in the last 30 days; number of drinks/day and number of drinks in a row; drug use: marijuana, cocaine, heroin, amphetamines, ecstasy, and benzodiazepines. A third survey in 2008 of n=187 pts (84 completed the 2008 drug and alcohol Q), documented smoking status, number of cigarettes/day, history of stopping and whether patients had sought or would seek advice about quitting from a health professional.

Patterns of alcohol consumption and drug use were similar between the 2002 and 2008 surveys (p>0.3). Binge drinking was associated with younger age (p=0.004, 2002; p = 0.01, 2008) but not with gender. In those that responded to both surveys there was a marginal reduction in alcohol consumption (p=0.06), in particular amongst males. Of the 187 in the smoking survey 28% had never smoked and 20% were ex-smokers. Being a current smoker (52%) was associated with male gender (p=0.004) and recent drug use (p=0.05) and greater alcohol consumption (p=0.0005). Compared with other smokers those thinking of quitting were more interested in talking to clinic staff about quitting (p<0.0001) or reducing the risk of heart disease and cancer (p=0.0004).

These surveys demonstrate the high rates of multi-substance use in the WA HIV Cohort compared with the general population. An algorithm to establish the contribution of compounding risk factors against a background of immunodeficiency may be useful. The outpatient setting provides an opportunity for the multidisciplinary team to promote and maintain healthful behaviours.